EP3340912B1 - Verfahren und systeme zur anzeige elektrophysiologischer läsionen - Google Patents

Verfahren und systeme zur anzeige elektrophysiologischer läsionen Download PDF

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EP3340912B1
EP3340912B1 EP16779295.1A EP16779295A EP3340912B1 EP 3340912 B1 EP3340912 B1 EP 3340912B1 EP 16779295 A EP16779295 A EP 16779295A EP 3340912 B1 EP3340912 B1 EP 3340912B1
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Prior art keywords
surface model
geometric surface
lesion
texture map
ablation
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English (en)
French (fr)
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EP3340912A1 (de
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Eric J. Voth
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St Jude Medical Cardiology Division Inc
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St Jude Medical Cardiology Division Inc
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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/01—Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue
    • A61B5/015—By temperature mapping of body part
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/6852—Catheters
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T19/00—Manipulating 3D models or images for computer graphics
    • G06T19/20—Editing of 3D images, e.g. changing shapes or colours, aligning objects or positioning parts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00357—Endocardium
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00779—Power or energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00886—Duration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • A61B2034/104—Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure

Definitions

  • This disclosure relates to systems and methods for generating an electrophysiological map of a geometric structure. More particularly, this disclosure relates to computer-implemented systems and methods for rendering lesions on a model of a geometric structure, such as, for example, an intra-cardiac structure.
  • US 2012/029504 A1 relates to a system and method for presenting information representative of lesion formation in tissue during an ablation procedure, in particular for automatically characterizing lesion markers and placing the lesion markers onto an image or model of tissue so as to form a lesion formation map.
  • EP-A-2 549 441 relates to the field of display tools for supporting the diagnosis or planning of surgical or therapeutic interventions.
  • US-A-2009 221 999 relates to the field of thermal ablation devices for simulation and/or prediction of heat transport phenomena within an anatomical landscape.
  • US-A-2008 075 343 relates to a method for displaying regions of tissue which are of interest, positioned accurately in a three-dimensional reconstruction representation derived from a first image data set previously recorded.
  • At least some known systems facilitate displaying lesions (e.g., generated from ablation therapy) on generated surface models.
  • lesions are rendered as either brown spheres or brown surface patches, with a user-selectable radius.
  • the locations of the rendered lesions are determined solely based on user placement. That is, the lesions are not rendered based on potentially relevant parameter values such as power level, delivery duration, tissue contact force, lesion-size index (LSI), or force-time integral (FTI). Accordingly, it would be desirable to display lesions more accurately using multi-dimensional modeling systems.
  • the present disclosure is directed to a system for rendering lesions on a geometric surface model of a geometric structure.
  • the system includes a computer-based model construction system configured to create a three-dimensional (3D) texture map including a plurality of voxels each having a tissue necrosis value, increment the tissue necrosis values as a function of at least one parameter to generate a total tissue necrosis value for each voxel, render at least one lesion on the geometric surface model based on the total tissue necrosis values, and display the geometric surface model and the at least one rendered lesion.
  • 3D three-dimensional
  • the present disclosure is directed to a computer-implemented method of rendering lesions on a geometric surface model of a geometric structure.
  • the method includes creating a three-dimensional (3D) texture map including a plurality of voxels each having a tissue necrosis value, incrementing the tissue necrosis values as a function of at least one parameter to generate a total tissue necrosis value for each voxel, rendering at least one lesion on the geometric surface model based on the total tissue necrosis values, and displaying the geometric surface model and the at least one rendered lesion.
  • 3D three-dimensional
  • the present disclosure is directed to a processing apparatus for rendering lesions on a geometric surface model of a geometric structure.
  • the processing apparatus is configured to create a three-dimensional (3D) texture map including a plurality of voxels each having a tissue necrosis value, increment the tissue necrosis values as a function of at least one parameter to generate a total tissue necrosis value for each voxel, render at least one lesion on the geometric surface model based on the total tissue necrosis values, and display the geometric surface model and the at least one rendered lesion.
  • 3D three-dimensional
  • the disclosure provides systems and methods for rendering lesions on a geometric surface model of a geometric structure (e.g., of a cardiac structure).
  • a computer-based model construction system is configured to create a three-dimensional (3D) texture map including a plurality of voxels each having a tissue necrosis value. The tissue necrosis values are incremented according to at least one parameter to generate a total tissue necrosis value for each voxel. At least one lesion is rendered on the geometric surface model based on the total tissue necrosis values, and the geometric surface model and the at least one rendered lesion are display for a user.
  • Figure 1 illustrates one exemplary embodiment of a system 10 for generating a multi-dimensional surface model of one or more geometric structures.
  • the model generated by system 10 is a three-dimensional model.
  • system 10 in the generation of models of anatomic structures, and cardiac structures in particular, the present disclosure is not meant to be so limited. Rather, system 10, and the methods and techniques used thereby, may be applied to the generation of three-dimensional models of any number of geometric structures, including anatomic structures other than cardiac structures. However, for purposes of illustration and ease of description, the description below will be focused on the use of system 10 in the generation of three-dimensional models of cardiac structures.
  • the system 10 includes, among other components, a medical device and a model construction system 14.
  • medical device is a catheter 12
  • model construction system 14 includes, in part, a processing apparatus 16.
  • Processing apparatus 16 may take the form of an electronic control unit, for example, that is configured to construct a three-dimensional model of structures within the heart using data collected by catheter 12.
  • catheter 12 is configured to be inserted into a patient's body 18, and more particularly, into the patient's heart 20.
  • Catheter 12 may include a cable connector or interface 22, a handle 24, a shaft 26 having a proximal end 28 and a distal end 30 (as used herein, “proximal” refers to a direction toward the portion of the catheter 12 near the clinician, and “distal” refers to a direction away from the clinician and (generally) inside the body of a patient), and one or more sensors 32 (e.g., 32 1 , 32 2 , 32 3 ) mounted in or on shaft 26 of catheter 12. In this embodiment, sensors 32 are disposed at or near distal end 30 of shaft 26.
  • Catheter 12 may further include other conventional components such as, for example and without limitation, a temperature sensor, additional sensors or electrodes, ablation elements (e.g., ablation tip electrodes for delivering RF ablative energy, high intensity focused ultrasound ablation elements, etc.), and corresponding conductors or leads.
  • Connector 22 provides mechanical, fluid, and electrical connection(s) for cables, such as, for example, cables 34, 36 extending to model construction system 14 and/or other components of system 10 (e.g., a visualization, navigation, and/or mapping system (if separate and distinct from model construction system 14), an ablation generator, irrigation source, etc.).
  • Connector 22 is conventional in the art and is disposed at proximal end 28 of catheter 12, and handle 24 thereof, in particular.
  • Handle 24 which is disposed at proximal end 28 of shaft 26, provides a location for the clinician to hold catheter 12 and may further provide means for steering or guiding shaft 26 within body 18 of the patient.
  • handle 24 may include means to change the length of a steering wire extending through catheter 12 to distal end 30 of shaft 26 to steer shaft 26.
  • Handle 24 is also conventional in the art and it will be understood that the construction of handle 24 may vary.
  • catheter 12 may be robotically driven or controlled. Accordingly, rather than a clinician manipulating a handle to steer or guide catheter 12 and shaft 26 thereof, in such an embodiments, a robot is used to manipulate catheter 12.
  • Shaft 26 is an elongate, tubular, flexible member configured for movement within body 18.
  • Shaft 26 supports, for example and without limitation, sensors and/or electrodes mounted thereon, such as, for example, sensors 32, associated conductors, and possibly additional electronics used for signal processing and conditioning.
  • Shaft 26 may also permit transport, delivery, and/or removal of fluids (including irrigation fluids, cryogenic ablation fluids, and bodily fluids), medicines, and/or surgical tools or instruments.
  • Shaft 26 may be made from conventional materials such as polyurethane, and defines one or more lumens configured to house and/or transport electrical conductors, fluids, or surgical tools.
  • Shaft 26 may be introduced into a blood vessel or other structure within the body 18 through a conventional introducer. Shaft 26 may then be steered or guided through body 18 to a desired location, such as heart 20, using means well known in the art.
  • Sensors 32 mounted in or on shaft 26 of catheter 12 may be provided for a variety of diagnostic and therapeutic purposes including, for example and without limitation, electrophysiological studies, pacing, cardiac mapping, and ablation.
  • one or more of sensors 32 are provided to perform a location or position sensing function. More particularly, and as will be described in greater detail below, one or more of sensors 32 are configured to be a positioning sensor(s) that provides information relating to the location (position and orientation) of catheter 12, and distal end 30 of shaft 26 thereof, in particular, at certain points in time.
  • sensor(s) 32 can be used to collect location data points that correspond to the surface of, and/or other locations within, the structure of interest. These location data points can then be used by, for example, model construction system 14, in the construction of a three-dimensional model of the structure of interest, which will be described in greater detail below.
  • model construction system 14 For purposes of clarity and illustration, the description below will discuss an embodiment wherein multiple sensors 32 of catheter 12 comprise positioning sensors. It will be appreciated, however, that in other embodiments, which remain within the scope of the present disclosure, catheter 12 may comprise both one or more positioning sensors as well as other sensors configured to perform other diagnostic and/or therapeutic functions.
  • model construction system 14 is configured to construct a three-dimensional model of structures within the heart using, in part, location data collected by catheter 12. More particularly, processing apparatus 16 of model construction system 14 is configured to acquire location data points collected by sensor(s) 32 and to then use those location data points in the construction or generation of a model of the structure(s) to which the location data points correspond. In this embodiment, model construction system 14 acquires the location data points by functioning with sensors 32 to collect location data points.
  • model construction system 14 may simply acquire the location data points from sensors 32 or another component in system 10, such as, for example, a memory or other storage device that is part of model construction system 14 or accessible thereby, without affirmatively taking part in the collection of the location data points.
  • Model construction system 14 is configured to construct a three-dimensional model based on some or all of the collected location data points. For purposes of illustration and clarity, the description below will be limited to an embodiment wherein model construction system 14 is configured to both construct the model and also acquire location data points by functioning with sensor(s) 32 in the collection of the location data points. It will be appreciated, however, that other embodiments wherein model construction system 14 only acquires location data points from sensor(s) 32 and then constructs a three-dimensional model based thereon remain within the scope of the present disclosure.
  • model construction system 14 is configured to function with sensor(s) 32 to collect location data points that are used in the construction of a three-dimensional model.
  • Model construction system 14 may comprise an electric field-based system, such as, for example, the EnSite TM NavX TM system commercially available from St. Jude Medical, Inc., and generally shown with reference to U.S. Pat. No. 7,263,397 entitled "Method and Apparatus for Catheter Navigation and Location and Mapping in the Heart".
  • model construction system 14 may comprise other types of systems, such as, for example and without limitation: a magnetic-field based system such as the Carto TM system available from Biosense Webster, and as generally shown with reference to one or more of U.S. Pat. Nos. 6,498,944 entitled “Intrabody Measurement,” 6,788,967 entitled “Medical Diagnosis, Treatment and Imaging Systems,” and 6,690,963 entitled “System and Method for Determining the Location and Orientation of an Invasive Medical Instrument,", or the gMPS system from MediGuide Ltd., and as generally shown with reference to one or more of U.S. Pat. Nos.
  • a magnetic-field based system such as the Carto TM system available from Biosense Webster
  • 6,498,944 entitled “Intrabody Measurement”
  • 6,788,967 entitled “Medical Diagnosis, Treatment and Imaging Systems”
  • 6,690,963 entitled “System and Method for Determining the Location and Orientation of an Invasive Medical Instrument”
  • sensor(s) 32 of catheter 12 include positioning sensors, Sensor(s) 32 produce signals indicative of catheter location (position and/or orientation) information.
  • sensor(s) 32 may comprise one or more electrodes.
  • sensor(s) 32 may include one or more magnetic sensors configured to detect one or more characteristics of a low-strength magnetic field.
  • sensor(s) 32 may include magnetic coils disposed on or in shaft 26 of catheter 12.
  • model construction system 14 will hereinafter be described as including an electric field-based system, such as, for example, the EnSite TM NavX TM system identified above. It will be appreciated that while the description below is primarily limited to an embodiment wherein sensor(s) 32 include one or more electrodes, in other embodiments, sensor(s) 32 may include one or more magnetic field sensors (e.g., coils). Accordingly, model construction systems that include positioning sensor(s) other than the sensors or electrodes described below remain within the spirit and scope of the present disclosure.
  • model construction system 14 may include, among other possible components, a plurality of patch electrodes 38, a multiplex switch 40, a signal generator 42, and a display device 44. In other embodiments, some or all of these components are separate and distinct from model construction system 14 but are electrically connected to, and configured for communication with, model construction system 14.
  • Processing apparatus 16 may include a programmable microprocessor or microcontroller, or may include an application specific integrated circuit (ASIC). Processing apparatus 16 may include a central processing unit (CPU) and an input/output (I/O) interface through which the processing apparatus 16 may receive a plurality of input signals including, for example, signals generated by patch electrodes 38 and sensor(s) 32, and generate a plurality of output signals including, for example, those used to control and/or provide data to, for example, display device 44 and switch 40. Processing apparatus 16 may be configured to perform various functions, such as those described in greater detail above and below, with appropriate programming instructions or code (i.e., software). Accordingly, processing apparatus 16 is programmed with one or more computer programs encoded on a computer storage medium for performing the functionality described herein.
  • CPU central processing unit
  • I/O input/output
  • Processing apparatus 16 may be configured to perform various functions, such as those described in greater detail above and below, with appropriate programming instructions or code (i.e., software). Accordingly, processing apparatus 16 is programmed
  • patch electrodes 38 are provided to generate electrical signals used, for example, in determining the position and orientation of catheter 12.
  • patch electrodes 38 are placed orthogonally on the surface of body 18 and are used to create axes-specific electric fields within body 18.
  • patch electrodes 38 X1 , 38 X2 may be placed along a first (x) axis.
  • patch electrodes 38 Y1 , 38 Y2 may be placed along a second (y) axis, and patch electrodes 38 Z1 , 38 Z2 may be placed along a third (z) axis.
  • Each of patch electrodes 38 may be coupled to multiplex switch 40.
  • processing apparatus 16 is configured, through appropriate software, to provide control signals to switch 40 to thereby sequentially couple pairs of electrodes 38 to signal generator 42. Excitation of each pair of electrodes 38 generates an electric field within body 18 and within an area of interest such as heart 20. Voltage levels at non-excited electrodes 38, which are referenced to belly patch 38 B , are filtered and converted and provided to processing apparatus 16 for use as reference values.
  • sensor(s) 32 of catheter 12 are electrically coupled to processing apparatus 16 and are configured to serve a position sensing function. More particularly, sensor(s) 32 are placed within electric fields created in body 18 (e.g., within the heart) by exciting patch electrodes 38. For purposes of clarity and illustration only, the description below will be limited to an embodiment wherein a single sensor 32 is placed within electric fields. It will be appreciated, however, that in other embodiments that remain within the scope of the present disclosure, a plurality of sensors 32 can be placed within the electric fields and then positions and orientations of each sensor can be determined using the techniques described below.
  • sensor 32 When disposed within the electric fields, sensor 32 experiences voltages that are dependent on the location between patch electrodes 38 and the position of sensor 32 relative to tissue. Voltage measurement comparisons made between sensor 32 and patch electrodes 38 can be used to determine the location of sensor 32 relative to the tissue. Accordingly, as catheter 12 is swept about or along a particular area or surface of interest, processing apparatus 16 receives signals (location information) from sensor 32 reflecting changes in voltage levels on sensor 32 and from the non-energized patch electrodes 38.
  • the processing apparatus 16 may then determine the location (position and orientation) of sensor 32 and record it as a location data point 46 (also referred to herein as "data point 46" and illustrated in Figure 3 ) corresponding to a location of sensor 32, and therefore, a point on the surface or in the interior of the structure of interest being modeled, in a memory or storage device, such as memory 47, associated with or accessible by processing apparatus 16.
  • a location data point 46 also referred to herein as "data point 46" and illustrated in Figure 3
  • the raw location data represented by the signals received by processing apparatus 16 may be corrected by processing apparatus 16 to account for respiration, cardiac activity, and other artifacts using known or hereafter developed techniques.
  • locations of other portions of catheter 12 may be inferred from measurements at sensors 32, such as by interpolation or extrapolation, to generate further location data points 46.
  • the collection of location data points 46 (46 1 , 46 2 , ... , 46 n ) taken over time results in the formation of a point cloud 48 (best shown in Figure 3 ) stored in the memory or storage device.
  • Figures 4A-4D depict a plurality of exemplary non-orthogonal dipoles D 0 , D 1 , D 2 , and D 3 , set in a coordinate system 50.
  • the X-axis patch electrodes are designated X A and X B
  • the Y-axis patch electrodes are designated Y A and Y B
  • the Z-axis patch electrodes are designated Z A and Z B .
  • the potentials measured across an intra-cardiac sensor, such as sensor 32, resulting from a predetermined set of drive (source/sink) configurations may be combined algebraically to yield the same effective potential as would be obtained simply by driving a uniform current along the orthogonal axes.
  • Any two of the patch electrodes 38 X1 , 38 X2 , 38 Y1 , 38 Y2 , 38 Z1 , and 38 Z2 may be selected as a dipole source and drain with respect to a ground reference, e.g., belly patch 38 B , while the unexcited patch electrodes measure voltage with respect to the ground reference.
  • Sensor 32 placed in heart 20 is also exposed to the field for a current pulse and is measured with respect to ground (e.g., belly patch 38 B ).
  • multiple patch electrodes 38 may be arranged linearly along a common axis.
  • excitation of an electrode pair comprising one of patch electrodes 38 and an electrode mounted on catheter 12 generates an electric field.
  • the non-excited patch electrodes 38 may then measure potentials that can be used to determine the position of sensor 32.
  • the excitation of multiple electrode pairs comprising different patch electrodes 38 and the catheter-mounted electrode may be used to determine the position of sensor 32.
  • Data sets from each of patch electrodes 38 and the sensor 32 are all used to determine the location of sensor 32 within heart 20. After the voltage measurements are made, a different pair of patch electrodes 38 is excited by the current source and the voltage measurement process of the remaining patch electrodes 38 and sensor 32 takes place. Once the location of sensor 32 is determined, and as was described above, the location may be recorded as a data point 46 in the same manner described above. In some embodiments, prior to recording the location as a location data point, the raw location data represented by the signals received by processing apparatus 16 may be corrected by processing apparatus 16 to account for respiration, cardiac activity, and other artifacts using known or hereafter developed techniques. Accordingly, it will be appreciated that any number of techniques may be used to determine locations of sensor 32 and to, therefore, collect data points corresponding thereto, each of which remains within the spirit and scope of the present disclosure.
  • Figure 3 is illustrative of the point cloud 48 including location data points 46 1 , 46 2 , 46 n corresponding to a particular structure of interest being modeled. It will be appreciated that in practice, the point cloud 48 would generally include hundreds to hundreds of thousands of data points 46. For purposes of illustration and ease of description, however, the description below will be limited to a point cloud having a limited number of location data points, such as, for example, point cloud 48 including location data points 46.
  • a geometric surface model of the structure of interest may be generated.
  • lesions may be rendered on a geometric surface model.
  • the lesions are not rendered based on parameter values such as power level, delivery duration, tissue contact force, lesion-size index (LSI), and force-time integral (FTI).
  • LSI lesion-size index
  • FTI force-time integral
  • a three-dimensional (3D) texture map is used to include any or all of these parameters.
  • lesions may be rendered fully automatically by storing a tissue necrosis value for each voxel in the 3D texture map and indexing it into a 1D (or 2D) texture map for display.
  • FIG. 5 is a flowchart of a method 500 for rendering lesions on a geometric surface model.
  • a scalar 3D texture map is created.
  • a texture map is an image (typically 2D, but possibly 1D or 3D) that is "painted" onto a polygon while the polygon is being drawn by graphics hardware.
  • Each vertex of the polygon has coordinates in (x, y, z) space, in addition to one or more coordinates in the texture map, which describe the portion of the texture map that gets painted onto that polygon.
  • the effect of clouds or grass may be represented by drawing just a few polygons for the sky or ground, without having to draw each wisp of cloud or blade of grass as its own colored polygon (which would require significantly more computational resources).
  • the 3D texture map created in step 502 is large enough to include an entire bounding volume of the geometry model. Further, the 3D texture map is a lattice of voxels that each have an associated tissue necrosis value. In one embodiment, the 3D texture map has a 0.5 millimeter (mm) resolution over its entire volume. Alternatively, the 3D texture map may have any suitable resolution.
  • the tissue necrosis value of each voxel in the 3D map that is within a given distance of an ablation location is incremented as a function of one or more parameters to generate a total tissue necrosis value.
  • the parameters may include, distance from the ablation location, ablation power level, contact force, tissue temperature, etc.
  • the tissue necrosis values may be incremented as a function of at least one of a power level, a delivery duration, a tissue contact force, a lesion-size index, and a force-time integral associated with an ablation procedure.
  • the values for the parameters may be acquired, for example, using an instrument that applies ablation to generate the lesions. Accordingly, the lesions may be rendered in real-time as the ablation is occurring.
  • the incrementing function may be based on physiological theory, simulation, and/or experimental results. Further, the function may vary over time as well as distance.
  • the one or more lesions are rendered on the geometric surface model based on the total tissue necrosis values.
  • the total tissue necrosis values are indexed into a relatively small 1D (or 2D) texture map.
  • the 1D (or 2D) texture map may range from transparent (optionally with a reddish tinge) to a tannish or light burnt color. Storing the total necrosis value for each voxel allows neighboring lesions to merge into one another when rendered, with a single border zone, which is clinically accurate. Further, the border zone may transition from opaque to transparent, appearing "fuzzy" to emphasize that map data underneath may be of questionable validity.
  • any underlying electrophysiological data that is displayed e.g., peak voltage, local activation time, fractionation value, and/or any other clinically useful measurement or computation
  • peak voltage e.g., peak voltage
  • local activation time e.g., local activation time
  • fractionation value e.g., fractionation value
  • any other clinically useful measurement or computation e.g., peak voltage, local activation time, fractionation value, and/or any other clinically useful measurement or computation
  • the lesions may be displayed accurately, and multiple lesions or parts thereof may be rendered on the same facet of the geometric surface model, independent of the geometry resolution or facet size.
  • the lesions may be rendered directly on the geometric surface model itself, or may be rendered on a separate overlay layer (e.g., an offset surface that is slightly displaced in a normal direction relative to the geometric surface model, and that is transparent in regions where there are no lesions).
  • the overlay layer could be selectively displayed independent from the underlying geometric surface model in some embodiments.
  • the ablation location used to render a lesion may vary over time, resulting in a "spray-painting" effect for the rendered lesion.
  • each voxel in the 3D texture map also contains a stored tissue temperature value associated with that voxel location.
  • This tissue temperature value is incremented by a clinically relevant function and may take into account the temperature of neighboring points to mimic heat conduction.
  • the relevant voxels could "cool down" to full health (e.g., a tissue necrosis value of zero), some predetermined level of necrosis, or complete death, depending on the maximum temperature achieved. Further, if ablative RF energy is restarted, the temperature would begin rising again from its current level.
  • tissue type e.g., total energy delivered, power level, delivery duration, tissue contact force, LSI, and FTI
  • tissue type could be used in conjunction with temperature to determine the degree of tissue necrosis. That is, differences in heat absorption/dissipation due to specific characteristics of the tissue (e.g., thicker ventricular cardiac tissue as compared to thinner ventricular cardiac tissue) could be taken into account.
  • step 506 triangles of the geometric surface model are drawn using each geometric vertex of the triangles as an index into the 3D texture map of tissue necrosis values.
  • the resulting value may be used as an index into the 1D (or 2D) lesion texture map. That is, the geometry vertices are used as the texture coordinates to get the correct color index into the lesion spectrum.
  • the tissue necrosis and/or temperature value may be incremented in a relatively thin two-dimensional region surrounding the geometry model, instead of in full 3D.
  • the geometry could first be rendered into an empty 3D texture map to create a bitfield of texture voxels that intersect the surface model, since those are the only texture points that need to be colored.
  • the actual 3D necrosis texture map may be used as the bitfield.
  • the bitfield may be initialized to -1.0, and the graphics hardware or geometry renderer could draw the surface model into this texture map to set voxels intersecting the surface to an initial weight of 0.0. From then on during the procedure, the tissue necrosis values would only need to be computed for voxels that have a nonnegative weight.
  • scar/fibrosis information may be incorporated from an external imaging modality (e.g., late gadolinium enhancement magnetic resonance imaging (LGE MRI)) into this framework. If such an image is voxelized according to the fraction of scar/fibrosis information and properly registered to the geometry model, that information could be loaded directly into a texture map and rendered on the surface, along with the original mapping data and lesions.
  • an external imaging modality e.g., late gadolinium enhancement magnetic resonance imaging (LGE MRI)
  • the lesions may be rendered using any suitable size, color function, border zone, translucency, and/or sharpness.
  • Figures 6 and 7 are example maps 600 and 700 generated using the systems and methods described herein.
  • map 600 lesions 602 are rendered as substantially white, with a reddish tinged border zone.
  • map 700 lesions 702 are rendered as substantially brown.
  • maps 600 and 700 lesions 602 and 702 as rendered overlap in a natural and visually intuitive way.
  • the triangles are being rendered one vertex at a time, while all colormap interpolation is being handled in texture memory on a graphics card.
  • FIG. 8 is an example map 800 that includes lesions 802 generated with a varying ablation location. Maps 600, 700, and 800 all facilitate providing users with real-time feedback on energy delivery/lesion coverage during an ablation procedure.
  • model construction system 14, and particularly processing apparatus 16, as described above may include conventional processing apparatus known in the art, capable of executing pre-programmed instructions stored in an associated memory, all performing in accordance with the functionality described herein. It is contemplated that the methods described herein, including without limitation the method steps of embodiments of the invention, will be programmed in some embodiments, with the resulting software being stored in an associated memory and where so described, may also constitute the means for performing such methods. Implementation of the invention, in software, in view of the foregoing enabling description, would require no more than routine application of programming skills by one of ordinary skill in the art. Such a system may further be of the type having both ROM, RAM, a combination of non-volatile and volatile (modifiable) memory so that the software can be stored and yet allow storage and processing of dynamically produced data and/or signals.

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Claims (15)

  1. System zum Rendern von Läsionen auf einem geometrischen Oberflächenmodell einer geometrischen Struktur, wobei das System aufweist:
    ein Instrument zum Anwenden von Ablation, um die Läsionen zu erzeugen;
    ein computerbasiertes Modellkonstruktionssystem (14), das konfiguriert ist zur Kopplung mit einer Vorrichtung (12), die mindestens einen Sensor (32) aufweist, der konfiguriert ist zum Erfassen eines Satzes von Originalortsdatenpunkten (46) zur Erleichterung der Erzeugung des geometrischen Oberflächenmodells, wobei das computerbasierte Modellkonstruktionssystem (14) ferner konfiguriert ist zum:
    Erzeugen einer dreidimensionalen (3D) Texturkarte, die ein Gitternetz von Voxeln ist, wobei jedes Voxel einen zugehörigen Gewebenekrosewert aufweist und groß genug ist, um das gesamte Begrenzungsvolumen des geometrischen Oberflächenmodells aufzuweisen, wobei die 3D-Texturkarte auf ein Polygon gezeichnet wird, das Eckpunkte mit Koordinaten in einem 3D-Raum aufweist, zusätzlich zu einer oder mehreren Koordinaten in der 3D-Texturkarte, die einen Bereich der Texturkarte beschreiben, der auf dieses Polygon gezeichnet wird;
    Erhöhen eines Gewebenekrosewerts jedes Pixels in der 3D-Texturkarte, das innerhalb eines gegebenen Abstands zu einem Ablationsort ist, um ein Ausmaß, das eine inkrementierende Funktion eines Werts von mindestens einem Parameter ist, der zu einer Ablationsprozedur an dem Ablationsort gehört, um einen Gesamtgewebenekrosewert für jedes Pixel zu erzeugen, der ein Nekrose-Niveau während der Ablation anzeigt, wobei der Wert des mindestens einen Parameters durch Verwenden eines Instruments erfasst ist;
    Rendern von mindestens einer Läsion auf das geometrische Oberflächenmodell in Echtzeit, indem Dreiecke des geometrischen Oberflächenmodells unter Verwendung jedes geometrischen Eckpunkts der Dreiecke als Index in die 3D-Texturkarte basierend auf den Gesamtgewebenekrosewerten gezeichnet werden; und
    Anzeigen des geometrischen Oberflächenmodells und der mindestens einen gerenderten Läsion.
  2. System nach Anspruch 1, bei dem das System (14) konfiguriert ist zum Erhöhen der Gewebenekrosewerte um ein Maß, das eine Funktion eines Abstands von einem Ablationsort ist.
  3. System nach Anspruch 1 oder 2, bei dem das System (14) konfiguriert ist zum Erhöhen der Gewebenekrosewerte um ein Maß, das eine Funktion von mindestens einem Leistungspegel, einer Zuführungsdauer, einer Gewebekontaktkraft, einem Läsiongrößenindex und/oder einem Kraft-Zeit-Integral ist, die zu einer Ablationsprozedur, einem Gewebetyp und einer gelieferten Gesamtenergiemenge gehören.
  4. System nach einem der Ansprüche 1 bis 3, bei dem zum Rendern von mindestens einer Läsion auf das geometrische Oberflächenmodell das System (14) konfiguriert ist zum direkten Rendern von mindestens einer Läsion auf das geometrischen Oberflächenmodell.
  5. System nach einem der Ansprüche 1 bis 3, bei dem zum Rendern von mindestens einer Läsion auf das geometrische Oberflächenmodell das System (14) konfiguriert ist zum Rendern der mindestens einen Läsion auf einer Überlagerungsschicht, die relativ zu dem geometrischen Oberflächenmodell versetzt ist.
  6. Computerimplementiertes Verfahren zum Rendern von Läsionen auf einem geometrischen Oberflächenmodell einer geometrischen Struktur, wobei das Verfahren aufweist:
    Verbinden mit einer Vorrichtung (12), die mindestens einen Sensor (32) aufweist, der konfiguriert ist zum Erfassen eines Satzes von Originalortsdatenpunkten (46), um das Erzeugen des geometrischen Oberflächenmodells zu erleichtern;
    Erzeugen (502) einer dreidimensionalen (3D) Texturkarte, die ein Gitternetz von Voxeln ist, wobei jedes Voxel einen zugehörigen Gewebenekrosewert aufweist und groß genug ist, um ein gesamtes Begrenzungsvolumen des geometrischen Oberflächenmodells aufzuweisen, wobei die 3D-Texturkarte auf ein Polygon gezeichnet wird, das Eckpunkte mit Koordinaten in einem 3D-Raum aufweist, zusätzlich zu einer oder zu mehreren Koordinaten in der 3D-Texturkarte, die einen Bereich der Texturkarte beschreiben, der auf das Polygon gezeichnet wird;
    Erhöhen (504) eines Gewebenekrosewerts jedes Voxels in der 3D-Texturkarte, das innerhalb eines gegebenen Abstands zu einem Ablationsort liegt, um ein Ausmaß, das eine inkrementierende Funktion eines Werts von mindestens einem Parameter ist, der zu einer Ablationsprozedur an dem Ablationsort gehört, zur Erzeugung eines Gesamtgewebenekrosewerts für jedes Pixel, der ein Nekrose-Niveau während der Ablation angibt, wobei der Wert des mindestens einen Parameters erfasst wird, indem ein Instrument zur Anwendung der Ablation verwendet wird, um die Läsionen zu erzeugen;
    Rendern (506) von mindestens einer Läsion auf das geometrische Oberflächenmodell in Echtzeit, indem Dreiecke des geometrischen Oberflächenmodells unter Verwendung jedes geometrischen Eckpunkts der Dreiecke als Index in die 3D-Texturkarte basierend auf den Gesamtgewebenekrosewerten gezeichnet werden; und
    Anzeigen des geometrischen Oberflächenmodells und der mindestens einen gerenderten Läsion.
  7. Verfahren nach Anspruch 6, bei dem das Erhöhen (504) der Gewebenekrosewerte ein Erhöhen der Gesamtgewebenekrosewerte um ein Ausmaß aufweist, das eine Funktion eines Abstands von einem Ablationsort ist.
  8. Verfahren nach Anspruch 6 oder 7, bei dem das Erhöhen (504) der Gewebenekrosewerte ein Erhöhen der Gewebenekrosewerte um ein Ausmaß aufweist, das eine Funktion von mindestens einem Leistungspegel, einer Zuführungsdauer, einer Gewebekontaktkraft, einem Läsiongrößenindex und/oder einem Kraft-Zeit-Integral ist, die zu einer Ablationsprozedur gehören.
  9. Verfahren nach einem der Ansprüche 6 bis 8, bei dem das Rendern (506) von mindestens einer Läsion auf das geometrische Oberflächenmodell ein direktes Rendern von mindestens einer Läsion auf das Oberflächenmodell aufweist.
  10. Verfahren nach einem der Ansprüche 6 bis 8, bei dem das Rendern (506) von mindestens einer Läsion auf das geometrische Oberflächenmodell ein Rendern von mindestens einer Läsion auf eine Überlagerungsschicht aufweist, die relativ zu dem geometrischen Oberflächenmodell versetzt ist.
  11. Verarbeitungsvorrichtung zum Rendern von Läsionen auf ein geometrisches Oberflächenmodell einer geometrischen Struktur, wobei die Verarbeitungsvorrichtung (16) konfiguriert ist zum:
    Verbinden mit einer Vorrichtung (12), die mindestens einen Sensor (32) aufweist, der konfiguriert ist zum Erfassen eines Satzes von Originalortsdatenpunkten (46), um das Erzeugen des geometrischen Oberflächenmodells zu erleichtern;
    Erzeugen einer dreidimensionalen (3D) Texturkarte, die ein Gitternetz von Voxeln ist, wobei jedes Voxel einen zugehörigen Gewebenekrosewert aufweist und groß genug ist, um ein gesamtes Begrenzungsvolumen des geometrischen Oberflächenmodells aufzuweisen, wobei die 3D-Texturkarte auf ein Polygon gezeichnet wird, das Eckpunkte mit Koordinaten in einem 3D-Raum aufweist, zusätzlich zu einer oder mehreren Koordinaten in der 3D-Texturkarte, die einen Bereich der Texturkarte beschreiben, der auf das Polygon gezeichnet wird;
    Erhöhen eines Gewebenekrosewerts jedes Voxels in der 3D-Texturkarte, das innerhalb eines gegebenen Abstands zu einem Ablationsort liegt, um ein Ausmaß, das eine inkrementierende Funktion eines Werts von mindestens einem Parameter ist, der zu einer Ablationsprozedur an dem Ablationsort gehört, um einen Gesamtgewebenekrosewert für jedes Pixel zu erzeugen, der ein Nekrose-Niveau nach der Ablation angibt, wobei der Wert des mindestens einen Parameters erfasst wird, indem ein Instrument zum Anwenden der Ablation verwendet wird, um die Läsionen zu erzeugen;
    Rendern (506) von mindestens einer Läsion auf das geometrische Oberflächenmodell in Echtzeit, indem Dreiecke des geometrischen Oberflächenmodells unter Verwendung jedes geometrischen Eckpunkts der Dreiecke als Index in die 3D-Texturkarte basierend auf den Gesamtgewebenekrosewerten gezeichnet werden; und
    Anzeigen des geometrischen Oberflächenmodells und der mindestens einen gerenderten Läsion.
  12. Verarbeitungsvorrichtung nach Anspruch 12, bei der die Verarbeitungsvorrichtung (16) konfiguriert ist zum Erhöhen der Gewebenekrosewerte um ein Ausmaß, das eine Funktion eines Abstands von einem Ablationsort ist.
  13. Verarbeitungsvorrichtung nach Anspruch 11 oder 12, bei der die Verarbeitungsvorrichtung (16) konfiguriert ist zum Erhöhen der Gewebenekrosewerte um ein Ausmaß, das eine Funktion von mindestens einem Leistungspegel, einer Zuführungsdauer, einer Gewebekontaktkraft, einem Läsiongrößenindex und/oder einem Kraft-Zeit-Integral ist, die zu einer Ablationsprozedur gehören.
  14. Verarbeitungsvorrichtung nach einem der Ansprüche 11 bis 13, bei der zum Rendern der mindestens einen Läsion auf das geometrische Oberflächenmodell die Verarbeitungsvorrichtung konfiguriert ist zum direkten Rendern der mindestens einen Läsion auf das Oberflächenmodell.
  15. Verarbeitungsvorrichtung nach einem der Ansprüche 11 bis 13, bei der zum Rendern der mindestens einen Läsion auf das geometrische Oberflächenmodell die Verarbeitungsvorrichtung (16) konfiguriert ist zum Rendern der mindestens einen Läsion auf einer Überlagerungsschicht, die relativ zu dem geometrischen Oberflächenmodell versetzt ist.
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